Congenital adrenal hyperplasia (CAH) is an inherited disorder of adrenal steroidogenesis often diagnosed in infancy. Gynecologists may encounter adult patients with CAH due to the clinical effects of...

Congenital adrenal hyperplasia (CAH) is an inherited disorder of adrenal steroidogenesis often diagnosed in infancy. Gynecologists may encounter adult patients with CAH due to the clinical effects of increased androgens, e.g. hirsutism, clitoromegaly, oligomenorrhea, or, rarely, pelvic masses. This case report reviews the association of para-ovarian adrenal rest tumors with CAH, and the role of gynecologists in their evaluation and treatment. A 23-year-old woman with CAH (21-hydroxyase deficiency) untreated for the past 5 years presented with a pelvic mass and elevated serum testosterone (1433 ng/dL) and plasma ACTH (1117 pg/mL). Intraoperative findings revealed multiple retroperitoneal masses. Final pathology demonstrated adrenal rest tissue. Para-ovarian and ovarian adrenal rest tumors may present as a rare gynecologic manifestation in patients with untreated CAH.

CONCLUSIONS: Laparoscopic staging surgery performed for early stage ovarian cancer has better long term survival outcomes than the literature report. Laparoscopic treatment by a trained gynecologic oncologist is an ideal alternative for early stage ovarian cancer with the advantage of minimal invasiveness.

CONCLUSIONS: For women with a prior CD for arrest of descent, VBAC success rates are high. This suggests that arrest of descent is mostly dependent on factors unique to each pregnancy and not due to an inadequate pelvis or recurring conditions. Women with a prior CD for arrest of descent should not be discouraged from attempting TOLAC in a subsequent pregnancy due to concerns about the likelihood of success.

CONCLUSIONS: Although metastases to the head and neck occur infrequently, they should be considered when evaluating any unusual subcutaneous mass in the head and neck. RCC should not be discounted when sites as unlikely as the calvaria are evaluated. Treatment of metastatic renal cell carcinoma is complex, and the optimal regimen for achieving a lasting response without severe toxicity has not yet been defined.

CONCLUSIONS: Maritime military mass casualty incidents are challenging, but the U.S. Navy's casualty-receiving ships are ready to perform RDCR at sea. Activation of the ship's WBB to transfuse WFWB is essential for hemostatic resuscitations afloat.

Angiosarcomas of the uterine is a malignant and poor prognostic tumor and can either be a primary sarcoma or arising secondary to radiotherapy of a more complex tumor. Primary uterine angiosarcomas a...

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Angiosarcomas of the uterine is a malignant and poor prognostic tumor and can either be a primary sarcoma or arising secondary to radiotherapy of a more complex tumor. Primary uterine angiosarcomas are exceptional and probably arise from embryonic vascular remnants, teratoma or from the rich uterine vasculature. We reported a rare case of primary angiosarcoma of uterine that at the time of diagnosis presented with sign and symptom of local and distant metastasis. The patient presented with dyspnea, chest pain, and history of vaginal bleeding and pelvic pain. The physical exam revealed pallor, prominent jugular pulse pressure, a palpable fixed mass in the pelvic however vaginal exam was unremarkable. Transthoracic echocardiography (TTE) revealed massive pericardial effusion and also a large mass in the right atrium. The abdominal ultrasound showed echogenic and poor echogenic segments in uterine mass combined with central necrosis. The patient underwent total hysterectomy and Bilateral salpingo-oophorectomy followed by radiotherapy and adjuvant chemotherapy. The patient underwent open heart surgery with resection of cardiac mass and further received a four cycle of radiotherapy (50 MG) to the mediastinum. The further follow-up (6 month) revealed no recurrence of tumor in a mediastinum. However, patient died from metastasis to the liver and its hepatic failure sequels.

A 53-year-old obese woman was referred because of sudden onset of dyspnea and chronic vaginal bleeding. In addition to severe anemia, multiple pulmonary emboli were identified. Pelvic imaging showed ...

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A 53-year-old obese woman was referred because of sudden onset of dyspnea and chronic vaginal bleeding. In addition to severe anemia, multiple pulmonary emboli were identified. Pelvic imaging showed an irregular-shaped mass in the region of the endocervix extending to the lower uterine segment. After successful anticoagulant therapy, followed by placement of an inferior vena cava filter, transabdominal hysterectomy and bilateral salpingo-oophorectomy were performed. An immunopathological study resulted in the diagnosis of endocervical serous carcinoma. After the identification of a high level of microsatellite instability (MSI), an immunohistochemical analysis of mismatch repair (MMR) proteins showed the isolated loss of PMS2. Germline testing of MMR genes showed no mutations, indicating that the high MSI had occurred as a result of sporadic isolated loss of the PMS2 gene expression.